THE EVOLUTION OF RISK MANAGEMENT IN HEALTH ORGANISATIONS FROM AN OPERATIVE MECHANISM TO A CULTURAL PERSPECTIVE

Nowadays risk management represents one of the most important and visible competences in the organisation of health services: for example, we may remember that some Regions in Italy necessarily request the implementation of training courses on risk management for the whole social and health personnel, in order to get accreditation by the National Health Service. However, we think that risk management governance, which is also articulated in sophisticated operative mechanisms (incident reporting, FMEA-FMECA, root cause analysis, and so on), belongs first of all to a managerial cultural model, in which the sense of unexpected is normally a part of an organisation’s life, as referred to both in institutional terms (as an enterprise) and in sectorial terms (dealing with health). Indeed, focusing on the risk, besides being a physiological component of the clinical / health environment, has over time become a real managerial competence, mainly thanks to the more and more entrepreneurial vision of health (in Italy, since 1992 even the public health organisations work according to these criteria). It is clear, however, that risk management is a part of the broader commitment of health organisations when implementing quality in health care services. According to the considerations so far developed, in this work we want to represent in particular the case study of Casa di Cura Tortorella s.p.a. (Salerno, Italy), active in a particular operational mechanism of risk management, intended to strengthen the logistical process of SALA (sound alike, look alike) medicines, potentially exposed (from the entrance in the warehouse to the picking from the departmental pharmacy) to a dangerous confusion regarding names, dosages for use, packaging and other similar appearances, which in some cases may be harmful if not fatal, in case of mixing up. Using the methodology of case study, we want to highlight, as purpose of the paper, that the adoption of merely operational mechanisms of risk management, although useful on its own, would have a low impact, if it was not supported by a comprehensive training program (for any operator involved) and by a new organisational and cultural role, namely the ‘team leader nurses’, with responsibility for coordination and reporting.